A new draft national framework that aims to improve the care of people with learning disabilities, shifting services away from hospital care and towards community-based settings, has been published.
The draft service model, published by NHS England, the Local Government Association (LGA), and the Association of Directors of Adult Social Services (ADASS), sets out 9 overarching principles that define what ‘good’ services for people with learning disabilities and/or autism whose behaviour challenges should look like.
This is the latest piece of work to emerge from the Transforming Care for People with Learning Disabilities programme, which is a joint initiative between the NHS England, the LGA, ADASS, the Care Quality Commission, Health Education England and the Department of Health.
The 9 principles are:
• Providing more proactive, preventative care, with better identification of people at risk and early intervention
• Empowering people with a learning disability and/or autism, for instance through the expansion of personal budgets, personal health budgets and independent advocacy
• Supporting families to care for their children at home, and providing high-quality social care with appropriate skills
• Providing greater choice and security in housing
• Ensuring access to activities and services that enable people with a learning disability and/or autism to lead a fulfilling, purposeful life, such as education and leisure
• Ensuring access to mainstream health services, including in the community
• Providing specialist multi-disciplinary support in the community, including intensively when necessary to avoid admission to hospital
• Ensuring that services aimed at keeping people out of trouble with the criminal justice system are able to address the needs of people with learning disabilities and/or autism, and that the right specialist services are in place in the community to support people with a learning disability and/or autism who pose a risk to others
• Providing hospital services that are high-quality and assess, treat and discharge people with a learning disability as quickly as possible.
These principles will underpin how local services are redesigned over the coming months and years – allowing for local innovation and differing local needs and circumstances, while ensuring consistency in terms of what patients and their families should be able to expect from local decision-makers.
The service model has been co-produced with providers, commissioners, health and care professionals and people with learning disabilities and their families.
It will be used and tested immediately by the five ‘fast track’ areas announced by NHS England chief executive Simon Stevens at the NHS Confederation conference, who will use it to inform their transformation plans over the summer of 2015, and test it against the reality on the ground. NHS England, the LGA and ADASS will refine the guidance in response to any feedback.
NHS England will also continue to seek the views of clinicians, commissioners, providers, people with learning disabilities and/or autism who have a mental health condition or display behaviour that challenges (including offending behaviours) and their families, ahead of the publication of a final version in autumn 2015. This will ensure it’s available to help commissioners plan services and budgets for 2016/17.
As part of, and in line with, the priorities of the Transforming Care programme, it is intended that this will involve a significant shift in commissioning towards high quality community-based services over the next 18 months, allowing the closure of inpatient beds and facilities.
Welcome guidelines
Jolanta Lasota, CEO Ambitious about Autism, welcomed the guidelines. “It is particularly encouraging to see access to leisure activities included in the principles,” she said. “We have found that for the students at our TreeHouse School and Ambitious College, access to vocational and leisure programmes including horticulture, equine and photography are really important for their enjoyment and education. These activities can also help to find a career path, so it is crucial to their development.
“Whilst education is crucial to personal development, it can only be effective within a wider framework of good health and social care arrangements. We are delighted to see all-round quality of care for those with autism being addressed by the NHS and hope it goes a long way to supporting those with autism and other less visible disabilities.”
